Juicebox Podcast: Type 1 Diabetes
Episode #1824: "Insurance Let Me Down – Part 1"
Host: Scott Benner
Guest: Laura Keller
Date: April 14, 2026
Episode Overview
In this episode, Scott Benner invites Laura Keller, a seasoned diabetes advocate and person with type 1 diabetes, to share her decades-long professional and personal experience. The main focus is Laura’s recent, deeply frustrating ordeal with insurance coverage for diabetes technology, despite being highly knowledgeable and proactive. Their honest, wide-ranging discussion offers valuable strategies, validation, and solidarity to people navigating the healthcare system with a chronic illness, especially diabetes.
Key Discussion Points and Insights
1. Laura Keller's Background and Perspective
- Laura is 52, identifies as Gen X, and has lived with type 1 diabetes for 27 years.
- She spent 25 years at the American Diabetes Association (ADA), mostly in advocacy, rising to VP of grassroots advocacy.
- Laura is passionate about nonprofit work and continues consulting and volunteering post-retirement.
- Early career included working with diabetic camps, family retreats, fundraising events, and later, significant advocacy for people with diabetes (02:42–04:26).
Notable Quote:
"I got really into advocacy, not because I thought that was going to be a career, but... I retired from the ADA about three years ago now as the vice president of grassroots advocacy."
— Laura (03:35)
2. Gen X Mentality, Direct Communication, and Self-Advocacy
- Scott and Laura reflect on their Gen X upbringing and its impact on confidence and self-advocacy.
- Discuss gender differences in advocacy, especially in healthcare and educational settings.
- Women often dismissed as “emotional” when advocating for children with T1D, making male ally presence and even sending communications from a husband’s email more effective (11:12–13:04).
Notable Quote:
"If you have to, just bring a man, even if the man is your bartender, your dad, your hairdresser, it doesn't matter. You put a man in that room... they'll take you more seriously. I also used to tell moms... send the email... from your husband's email address... Every single time... they would get a better response."
— Laura (11:45–13:04)
Notable Quote:
"People have baked in preconceptions. I don't think they're conscious even."
— Scott (16:32)
3. Family Diabetes History and Shifting Standards of Care
- Laura’s father and his half-brother were diagnosed with T1D at similar ages. Her mother, a nurse, was advised not to have children due to risk, but ignored the advice.
- Major differences in diabetes management over a generation: her father used outdated insulin regimens until Laura’s diagnosis prompted advocacy and modern care implementation.
- Family humor and resilience helped normalize living with diabetes (17:53–24:30).
Notable Quote:
"Once I got diagnosed and I realized how different his diabetes management was compared to what mine was... that was just shocking to realize that he was working on old data."
— Laura (19:42)
- After connecting her father with modern resources and endocrinologists, his diabetes care improved dramatically.
- Family background is Swedish/Nordic, which both Scott and Laura note appears correlated with higher T1D prevalence (26:28–27:28).
4. Laura’s Career at the ADA and Shifts in Diabetes Advocacy
- Laura shares pride in legislative successes in protecting children with diabetes in schools—but notes setbacks and rollbacks in protections, costs, and access to care in recent years (27:39–28:49).
- Specific concern: the Department of Education revoking disabilities protections, school systems questioning children's need for 504 plans and their right to accommodations (28:54–30:08).
- The conversation pivots to the central theme: insurance barriers and Laura's recent personal experience.
5. Laura’s Insurance Ordeal—A Case Study in Barriers to Diabetes Tech
Researching and Selecting a Plan (32:24–34:02)
- Laura, an expert on advocacy and insurance, thoroughly researched all options for coverage when her previous insurance plan left Arizona.
- She double-checked provider directories, formularies (PDLs), and even used AI for further confirmation; everything indicated proper coverage.
Notable Moment:
"I looked at the other plans. I looked at who covers my endocrinologist, all of the things... I searched for insulin, I searched for insulin pumps, I search for CGMs... Nothing came up... that must mean they cover those things, right?"
— Laura (32:20–33:18)
Denials and Brick Walls (34:02–39:02)
- Upon trying to refill necessary supplies, both her CGM and Pods were denied for “not medically necessary.”
- Repeated phone calls, appeals, continual requirements for more paperwork, claim denials with no notification, and lack of information transparency.
- Emotional and logistical burnout—frustration leading Laura, seasoned and tough, to tears.
Quotes:
"I started crying. I started crying because I was so mad at myself... and they so didn't understand what type 1 diabetes was."
— Laura (37:31–37:54)
Playing the ‘Paperwork Game’ and Systemic Sabotage (39:06–41:06)
- Endless cycle of resubmitting paperwork, miscommunication between insurer and endo’s office, and lack of clarity frustrate the process for weeks.
- Only persistent, near-daily follow-up barely keeps the process moving.
- Support from Omnipod (“best customer service in the world”) and local pharmacists is crucial, but ultimately, the insurance makes it almost impossible to get coverage.
Notable Moment:
"If you don't like people with type 1 diabetes, just put it on your damn website. Just be honest."
— Laura (40:49–41:06)
Scott’s Observation:
"The rigmarole is set up to try to get you to give up."
(41:06–41:11)
Financial Realities and Coverage Gaps (41:11–43:25)
- Laura’s initial plan required a $5,000 deductible plus 40% coinsurance for Pods and CGMs. Even with a revised plan (after income change), she still faces steep co-pays until the out-of-pocket max is reached.
- Insurer forces her to switch CGM brand (Libre instead of Dexcom), affecting the feature set she relies on for daily management.
- Laura stresses that these are not just policy issues—they have direct, daily, negative impacts on health and quality of life.
Notable Quotes & Memorable Moments
- Gen X resilience:
"That means to me, you don't piss me off. If you push me too far, I will find a way to come back and kick your ass. Ethically, of course." — Laura (04:33) - On external validation:
"It would bother me if everyone liked me. What would I be then, like, just this kind of milquetoast thing that is okay for everybody?" — Scott (07:41) - Insurance denial as the ultimate frustration:
"I was told by Ambetter that an insulin pump was not medically necessary..." — Laura (34:02) - Toxic paperwork:
"Even though I'm a trained professional... it's a lot. And I started crying. I started crying because I was so mad at myself, right?" — Laura (37:31) - Systemic barriers:
"The rigmarole is set up to try to get you to give up." — Scott (41:06) - Advocacy reality check:
"If you don't dog them and call them and call them, that's how people give up. That's how people spend all this money out of pocket." — Laura (41:11) - On insurer’s lack of transparency:
"You also could put a statement on your plan about how you cover type 1 diabetes ... just be honest." — Laura (40:49)
Important Segment Timestamps
- Laura introduces herself (background in diabetes): 02:24–04:26
- Gen X, communication, and advocacy style: 04:26–11:12
- Educational/advocacy strategies for women: 11:12–13:04
- Family diabetes history and generational change: 17:53–27:00
- Challenges in insurance/ADA career perspective: 27:39–30:08
- Super-detailed insurance story begins: 32:24
- First coverage denials and emotional response: 34:02–39:02
- Systemic insurance barriers and the role of persistence: 41:02–43:25
Tone and Takeaways
- The tone is candid, relatable, and sometimes intentionally humorous—a safe space to acknowledge and vent about the true emotional and pragmatic toll of chronic illness administration.
- The discussion is empowering; despite setbacks, Laura and Scott stress persistence, community, and self-advocacy.
- Practical advice is woven throughout: don’t trust “comparable plans” at face value, overcommunicate, and tap into patient-as-consumer strategies.
- The episode ends with Laura caught in the insurance labyrinth but determined to keep fighting—inspiring listeners not to give up and to seek community and resources.
Note: This is Part 1 of a two-part series; Part 2 continues Laura’s story with additional detail and strategies.
